Displaced Cuneiform Fractures: Causes, Symptoms & Treatment

Displaced cuneiform fractures are serious injuries and should be diagnosed and treated as soon as possible. The three cuneiform bones (medial cuneiform, intermediate cuneiform, and lateral cuneiform) make up the inner midfoot. They help reduce shock absorption when walking. 

Cuneiform fractures that go untreated can cause chronic pain and disability. 

In this article, we will be discussing how displaced cuneiform fractures are treated. A displaced fracture is when a bone breaks but the pieces are not aligned properly. 

Treatment for displaced cuneiform fractures includes immobilization and surgery.

Causes of a Displaced Cuneiform Fracture (Medial, Intermediate, and Lateral Cuneiform)

Due to their positioning in the foot, the cuneiform bones are exposed to many forces during the walking and running cycle. They are highly prone to injuries. Direct trauma such as blows to the foot, twisting injuries, and falls from heights can cause cuneiform fractures. 

Luckily, the blood supply to the cuneiform bones is excellent, and isolated fractures happen less commonly. 

Cuneiform avulsion fractures can be seen when there is an injury to the Lisfranc ligament or ligaments that connect to the cuneiform bone. During the injury, the ligament can pull away a piece of bone, resulting in an avulsion fracture. 

Stress fractures can happen from repetitive activities that cause repetitive stress to be placed on the cuneiform bones. These activities include running, jumping, hopping, and marching. Certain sports such as basketball and football can also increase the likelihood of a stress fracture. Untreated stress fractures can turn into displaced fractures. 

Symptoms of a displaced cuneiform fracture

When a cuneiform fracture is displaced, it’s usually the result of a forceful injury or from an untreated nondisplaced stress fracture of the cuneiform. 

Some of the symptoms of a displaced cuneiform fracture include: 

• Pain and swelling of the midfoot
• Inability to bear weight on the foot
• Bruising
• Instability of the foot joints
• Pain when moving the foot
• Pain that persists with rest

How to Diagnose a Displaced Cuneiform Fracture

If you have sudden pain in the foot and suspect that you have broken your cuneiform bone you should contact a local foot doctor or go to the Emergency room.

Your doctor will obtain a history and perform a physical exam. Your doctor will be checking for signs of bruising and swelling in the midfoot. They will locate the area of pain by applying light pressure to the midfoot. 

If your doctor suspects that a broken bone is present, he/she will order imaging tests to confirm the presence of a fracture. 

X-Ray

Your doctor will order x-rays of the foot to determine whether a cuneiform fracture is present. X-rays are a cheap, non-invasive way to diagnose a fracture in the foot. An x-ray can help identify the presence of a cuneiform fracture, and whether it is nondisplaced or displaced. An x-ray can also identify if there is a cuneiform dislocation present.

MRI

At times, it may be difficult to identify a midfoot fracture on an x-ray. A Magnetic Resonance Imaging scan (MRI) may be needed. An MRI will show detailed images of the bones and soft tissues. It can help identify a cuneiform fracture and also any associated ligament injuries such as a Lisfranc ligament injury. 

CT 

If your doctor suspects that there are multiple fractures in the foot along with the cuneiform fractures, he/she may order a Computed Tomography scan (CT). A CT scan can identify the fractures, as well as how many pieces there are, and if the fractures extend into the joint spaces. 

To read more about Diagnosing Cuneiform Fractures, check out this article.

Treatment for Displaced Cuneiform Fractures in the Foot

If you have a displaced cuneiform fracture in the foot, your doctor will likely recommend surgery. If the fracture fragments are greater than 2mm apart, and if there is rotation of the fracture fragments, surgery is needed to realign the fracture fragments. 

Surgery would be done in the operating room under general anesthesia. Your doctor will realign the fracture and use plates and screws to hold the fracture fragments in place. You will need to remain off of your foot in a cast or splint for 6-8 weeks after the surgery. 

Your doctor will get x-rays in their office every 3-4 weeks after surgery to ensure that the bone is healing appropriately. After 6-8 weeks, you can transition to weight bearing in a walking cast for an additional 4 weeks before transitioning to athletic shoes. 

Full healing time for a displaced cuneiform fracture will take 3 months or longer. 

Physical therapy will be needed after healing is complete. This is because staying off of your foot for weeks can make your legs feel weak. Physical therapy can help improve strength, decrease pain, improve balance, and also improve strength. Physical therapy will need to be completed 3 times a week for 1 month. 

Complications of Cuneiform Fracture Surgery

Like with any foot surgery, complications can occur after surgery. 

Some complications that could occur after cuneiform fracture surgery include:

• Infection: Infections of the skin and bones can happen after surgery. If you notice redness in the foot, heat at the incision site, or pus draining from the incision site, contact your doctor immediately. You may need antibiotics. 
• Numbness: Numbness of certain parts of the foot can happen after surgery. Numbness can be temporary or permanent. 
• Non-union: In some cases, the fracture fragments may not heal. This results in a non-union of the fracture site. Non-unions are more commonly seen in diabetics and people who have a positive smoking history. These factors can cause the bone not to heal in an appropriate amount of time. A non-union may need to be treated using a bone stimulator or surgery.  

What Happens if You Walk on an Untreated Displaced Cuneiform Fracture?

Walking on an untreated displaced cuneiform fracture can cause further damage to the fracture site. The fracture fragments can displace even more. Not only that, but walking on a broken bone can lead to chronic pain and instability. 

Related article: Stress Fractures of the Foot: Causes, Symptoms & Treatment of a Stress Fracture

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